Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD158168 | OR |
Y | 207R00000X | Internist | MD00040497 | WA |
Y | 111NI0900X | Internist | MD00040497 | WA |
N | 207R00000X | Internist | MD158168 | OR |
N | 111NI0900X | Internist | MD158168 | OR |
NPI | 1265444723 |
---|---|
Provider Name | Mohamad Altayeb Al-Hafez |
First Address | San Francisco, CA 94117 |
Second Address | Clarkston, WA 99403-2829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 04/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H18562 | (02) | WA |